People experiencing bladder weakness are starting to feel more comfortable when asking for advice, but there is still plenty that pharmacy staff can do to help. Charles Gladwin explains

Bladder weakness is a difficult subject to talk about. Surveys show that 60 per cent of women say bladder weakness is still a taboo subject to them and are in denial about being affected by it. Only half of those surveyed are willing to discuss the issue with their partners, while another 50 per cent keep it to themselves completely. In addition, four fifths of women are embarrassed when buying products for bladder weakness.

The good news is that the stigma is lifting. “Perceptions are changing massively. Partly this is due to our talking about it and normalising it, and it is also due to the interaction with health professionals,” says Donna Wilson, TENA training and brand manager.

Even so, a TENA Lady survey found that only 15 per cent of British women would turn to their pharmacist for advice on bladder weakness. In its survey of 2,000 women, TENA found that 72 per cent of respondents would seek advice from their GP above anyone else. A further 16 per cent say they would get their advice from magazines, and 14 per cent from blogs.

So what can pharmacy do to be more approachable? For starters, when talking about the condition, refer to people ‘experiencing’ it. “Don’t say ‘suffer’, make it as upbeat as possible,” says Ms Wilson. She is concerned that “pharmacy staff might think this is dull, but there is so much to talk about.”

Her advice is: “Become the expert. Be up-to-date with the brands.” TENA has plenty on offer: “We give out sample bags, we have a lot of point-of-sale material, we support pharmacy with training and not just on TENA products, but on the condition.”

Another tip is not to ‘over-medicalise’ it. “The consultation room can make a bigger thing of it, so just go to a quieter area to discuss it. The community pharmacy is an ideal environment – it feels safe. People new to the category are more likely to discuss bladder weakness in the community pharmacy than the supermarket, even in those where there is a pharmacy,” she says.

Different perceptions

Two groups of people – new mums and menopausal women – are particularly likely to be interested in the products, but there is a difference in perception. While menopausal women might be more concerned about the stigma, pregnant women are more willing to discuss their bladder weakness as they have an obvious reason.

“Once in the bladder weakness market, it makes it more acceptable later on,” says Ms Wilson. She advises: “The light user will pick products up in the supermarket, but pharmacies need to capitalise on the heavier end. There are some products only sold into community pharmacies for heavier incontinence of bladder or bowel.”

And if you are concerned about the impact of internet sales, Ms Wilson responds with: “You can never get away from the need for face-to-face conversations. People do like that. People experiencing bladder weakness can be quite emotional and they do want to talk about it. They would rather do that with a person.”

Carla Berry, communications manager from Always, agrees: “Women are hardwired to want to talk. Bladder sensitivity is common, more common than many realise, it’s basically a normal occurrence – so it is definitely something we should be talking about.”

Striking a balance

P&G has spent nine years researching its new product, Always Discreet, testing it with thousands of women, so the company knows how embarrassed women are talking about urinary incontinence (UI). “Our marketing campaign is about giving women who have to manage a sensitive bladder the assurance that they are not alone and they are able to live their life to the full,” says Christina Turner, P&G brand manager, Femcare. “The campaign is designed to help make UI less of a forbidden topic of discussion through striking a balance between handling an understandably sensitive topic in an appropriate way.”

P&G research confirms that UI impacts women’s self-confidence, feeling of femininity and sense of freedom, says Ms Turner. “If a customer is browsing the category and looks like they need help, it is important to discreetly ask if they need any help or guidance.” Pharmacists can offer patients clinical and healthy living advice, including pelvic floor exercises at least three times a day, drinking the right amount of fluids, asking others to lift heavy objects, limiting caffeinated, alcoholic and fizzy drinks, opting for targeted pilates and yoga exercises rather than abdominal workouts, and wearing the right protection. More advice can be found from Always Discreet ambassador Dr Sarah Jarvis via www.alwaysdiscreet.co.uk.

The market

Sales of bladder weakness and urinary incontinence products continue to grow. One outcome of NHS budget measures means people are being supplied with smaller quantities of bladder weakness products.

“The NHS sees it as a non-acute area,” says Ms Wilson. “People are being pushed into retail as the pads are not available on the NHS in the quantities they need them. More and more people are having to buy them.”

Annual market sales for intimate hygiene (comprising ultra towels, maxi towels, liners, tampons and bladder weakness) to May were £398.2 million, up 3.4 per cent on the previous year. Bladder weakness saw the biggest increases in the sector – up 11.5 per cent across the total market, and 9.1 per cent in pharmacy. TENA claims a 76.9 per cent share of the total market, but 89.5 per cent of pharmacy.

Addressing the causes

Bladder weakness experienced through pregnancy is not just down to the pressure of the baby on the bladder and pelvic floor muscles. A hormone, relaxin, is also at work, softening the pelvic floor muscles to prepare the body for birth.

“Many women will continue to experience light bladder weakness post-pregnancy as the pelvic floor muscles can be over-stretched during childbirth and for women who have an episiotomy during labour, light bladder weakness can be a common experience,” says TENA.

“The key to maintaining control and strength of the pelvic floor muscles is to regularly undertake pelvic floor exercises. While 79 per cent of women are aware of the importance of pelvic floor exercises, just 10 per cent practise theirs daily. In fact, 44 per cent of women will just do these exercises as and when they remember, while another 33 per cent never do them.”

TENA has re-launched its free app, ‘my pff’, for smart phones and it now includes exercise settings and reminders to get women into the habit of exercising their pelvic floor muscles. There is also help and support with information about light bladder weakness and product information.

In a partnership that will run through to October, TENA has also been promoting awareness with Woman & Home magazine on Facebook. The campaign has invited readers to share their ‘carpe diem’ moments under the hashtag #Seizetheday.

What else is new?

Naturally, with the market buoyant, there has been a lot of activity in the sector. In July, Procter & Gamble launched Always Discreet for sensitive bladders.

This is a range of liners and pads that are up to 40 per cent thinner than the leading brand, while absorbing double what most women need. Pants are also included in what P&G describes as its biggest ever launch in femcare.

“The range is designed to sit within the Always ‘family’, overcoming much of the embarrassment women feel when purchasing urinary incontinence products in-store,” says P&G. The nationwide TV and print advertising campaign went live in August and has been “designed to speak to women about this embarrassing but common condition, in a way that is supportive and empathetic, but encourages them to ‘just get on with their lives’”.

TENA has launched TENA Lady Pants Night, a new night-time protection product that will join the existing TENA Lady Maxi Night. Nocturnal enuresis, or bedwetting, is more common than most people think, persisting in 1 per cent of adults over the age of 18. In addition, “one in six women in the UK claim that bladder weakness has affected their sleep whilst 42 per cent say that needing to go to the toilet often disturbs their night,” says TENA. TENA

Lady Pants Night are made from a cotton-like fabric for maximum comfort throughout the night. “The plain white pant design looks and feels like everyday underwear. For added security, the pad is highly absorbent and breathable.” The pants also control odour.

Astellas has issued a report on overactive bladder (OAB), following an expert panel meeting earlier this year. ‘Quality in the community: practical advice to optimise care and reduce inefficiencies in the local management of overactive bladder’ endorses the NICE recommendations that patients with OAB should be managed in the community setting with referral to secondary care when appropriate.

“GPs may not always be confident in diagnosing and managing OAB and if commissioning arrangements and pathways are not clear, understood and implemented by GPs, it can lead to referrals to secondary care, some of which are not completely necessary for the patient,” says the report. It can be downloaded from:

www.pulsetoday.co.uk/Uploads/2014/06/06/t/ c/f/astellas-CERTIFIED.pdf.